tbuckley/cabot-search huggingface dataset:
Abstract 14935: Deep Learning Pipeline for Frailty Screening Using the 12-Lead Electrocardiogram
Authors: Jonathan Afilalo, Ding Yi Zhang, Abhishek Tiwari, Philip Warrick
Journal: Circulation (2022)

Introduction: The electrocardiogram (ECG) contains information about age-related changes in cardiovascular physiology, which have been linked with the frailty syndrome. Hypothesis: We sought to develop and validate a predictive model leveraging the 12-lead ECG to screen for frailty as defined by a prospective reference standard. Methods: We conducted a population-based cohort study using data from the Canadian Longitudinal Study of Aging (CLSA). From 2010-2015, the CLSA enlisted a diverse and multi-ethnic sample of community-dwelling adults 45-85 years of age. Comprehensive phenotyping was performed through interviews at participants’ homes and assessments at data collection sites. Frailty was quantified by the 110-item Frailty Index (FI) Composite, consisting of self-reported comorbidities, blood tests, physical performance tests, body composition tests, cardiovascular and pulmonary tests, cognitive and sensory tests. After dividing our sample into training (80%) and test (20%) sets, we developed an end-to-end deep neural network to predict the FI score based on the 12-lead ECG time series. Results: A total of 26,700 ECGs with paired FI scores were evaluated. For classification of FI quintiles, a bidirectional long short-term memory (BiLSTM) neural network with a cross-entropy loss function achieved a 5-fold mean area under the receiver operating characteristics curve (AUROC) of 0.70 and area under the precision-recall curve (AUPRC) of 0.36. Predictive performance was superior for classification of the first (most robust) quintile that had AUROC 0.79 and AUPRC 0.46, and the fifth (most frail) quintile that had AUROC 0.79 and AUPRC 0.56, as compared to the middle quintiles that had AUROC 0.60-0.69 and AUPRC 0.27-0.29. Conclusions: Our deep learning model can be used to screen for high or low levels of frailty based on the readily available 12-lead ECG. Additional research is underway to gain insights into other representations of the ECG signal and relative importance of the ECG features.
Abstract 151: Effect Of Time From Collapse To Prehospital Return Of Spontaneous Circulation On Neurologically Favorable Survival In Patients With Out-of-hospital Cardiac Arrest At Nighttime Versus Daytime
Authors: Kazuya Tateishi, Yuichi Saito, Hideki Kitahara, Yoshio Tahara, Hiroshi Nonogi, Naohiro Yonemoto, Ken Nagao, Takanori Ikeda, Naoki Sato, Yoshio Kobayashi
Journal: Circulation (2022)

Background: Survival with favorable neurological outcomes is one of the goals in patients with out-of-hospital cardiac arrest (OHCA). Although previous studies have shown that a chance of neurologically intact survival was significantly lower at nighttime than at daytime in patients with OHCA, details are uncertain. The aim of this study was to evaluate the effect of time from collapse to prehospital return of spontaneous circulation (ROSC) on neurologically favorable survival in patients with OHCA at nighttime versus daytime. Methods: Using a nationwide OHCA registry database from 2005 to 2020 in Japan, a cohort of 1,902,986 patients with OHCA were retrospectively screened. In the present study, a total of 128,180 patients with witnessed OHCA who achieved prehospital ROSC were included. Nighttime was defined as 6:00 pm through 5:59 am. Neurologically favorable survival was defined as cerebral performance category score of 1 or 2 at 1 month. Results: Patients with witnessed OHCA at nighttime were likely to be younger (70.3±16.0 vs. 72.7±15.3 years, p&lt;0.001) and to have shorter time from collapse to resuscitation (8.1±7.3 vs. 8.6±7.2 min, p&lt;0.001) than those at daytime (6:00 am to 5:59 pm), while time from collapse to ROSC was longer in patients with OHCA at nighttime (18.3±12.7 vs. 17.9±12.2 min, p&lt;0.001). Overall, nighttime OHCA was associated with a lower rate of neurologically favorable survival at 1 months than daytime OHCA (30.9% vs. 31.8%, p&lt;0.001). The negative effect of nighttime OHCA on neurologically favorable survival was observed especially when the time from collapse to prehospital ROSC was within the range of 5 to 10 minutes (Figure). Conclusions: Nighttime rather than daytime OHCA was associated with neurological impaired survival or death at 1 month. The negative effect of nighttime OHCA was pronounced when prehospital ROSC was achieved 5 to 10 minutes after collapse.
Abstract 14757: Affected Patients and Clinical Outcomes After Transcatheter Relief of Superior Vena Cava Stenosis
Authors: Sarah Pradhan, Luisa E Raga, Sarosh P Batlivala, Nicholas Ollberding, Nicholas Szugye, Shabana Shahanavaz, Russel Hirsch
Journal: Circulation (2022)

Background: Obstruction of the superior vena cava (SVC) is thought to be mostly iatrogenic. Transcatheter interventions relieve stenosis with good long-term results, but there is a paucity of published data. We aim to describe patient characteristics and outcomes after transcatheter SVC intervention. Methods: Single-center, retrospective study of patients who underwent transcatheter SVC intervention from December 2006 to January 2020. Patient characteristics included age, gender, height, weight, and BSA. Clinical parameters included congenital heart disease (CHD), orthotopic heart transplant (OHT), upper extremity central venous line (CVL), extracorporeal membranous oxygenation (ECMO), mortality, and symptoms. Procedural data included pre- and post-intervention SVC pressure gradient, dimensions, and complications. Results: A total of 42 patients (median age 1.5 years, IQR [0.31-15], 64.2% male) underwent 81 procedures with 1 major complication, and 20 patients (47.6%) had re-interventions. 12 patients (31.5%) had symptoms. Affected patient groups were as follows: history of CVL (92.9%), CHD (76.2%), post-OHT (42.9%), and post-ECMO (30.9%). Those who underwent initial balloon angioplasty were significantly younger (mean ± SD: 3.9 ± 6.8 vs. 13.1 ± 11.3 years, p&lt;0.01) and smaller (15.9 ± 20.4 vs. 39.9 ± 31.2 kg, p&lt;0.01) than those with initial stent. A lower pressure gradient and larger post-intervention dimension was achieved after stenting (p&lt;0.01). Re-intervention rates were similar; 50% after balloon and 43.8% after stent, but nearly half of the angioplasty cohort resolved after repeat angioplasty alone, while most stents (85.7%) required serial re-dilation. Affected patient groups were not associated with re-intervention, and there were no significant differences in patient or procedural characteristics between those who did and did not require re-intervention. Conclusions: We describe at-risk groups who warrant surveillance of SVC stenosis in the setting of a low-symptom rate. Strongly consider balloon angioplasty as initial therapy, which may avoid the need for stent and subsequent re-dilations associated with growth. Re-intervention is likely after balloon angioplasty and stenting, but both are safe and effective.
Abstract 14755: Left Ventricular Three-Dimensional Speckle Tracking Echocardiography Predicts Adverse Clinical Outcomes in Heart Transplant Patients
Authors: Shuangshuang Zhu, Yuman Li, Mingxing Xie, Li Zhang
Journal: Circulation (2022)

Background: The prognostic value of 3D-GLS in HT recipients has not been evaluated. This study explored the long-term prognostic significance of 3D-GLS in HT recipients. Methods: The study comprised 296 consecutive patients who underwent HT between January 2015 and December 2019 at Union Hospital in Wuhan, China. All subjects underwent comprehensive transthoracic two-dimensional (2D) and 3D echocardiographic examinations. Patients were followed until January 1st, 2022. Major adverse cardiac events (MACE) were defined as a composite of heart failure hospitalization, re-transplantation and death. Results: After a median follow-up of 3.3 years, 53 HT patients experienced MACE. Patients with MACE displayed significantly impaired 2D-GLS and 3D-GLS compared with those without MACE. Kaplan-Meier analysis showed that the risk of MACE increased significantly with worsening tertiles of 2DGLS and 3DGLS (both log-rank p &lt; 0.001). Area under the curve for 3D-GLS was larger than that in 2D-GLS for MACE prediction. On multivariate Cox proportional hazards regression, 2D-GLS and 3D-GLS were independently associated with the MACE after adjustment for diabetes, history of rejection, hemoglobin, brain natriuretic peptide (BNP), and LV ejection fraction. In addition, 3D-GLS provided incremental prognostic value over 2D-GLS. Continuous net reclassification improvement analysis showed an improvement of + 23.3% was noted in the accuracy of classification between 3D-GLS and 2D-GLS. Conclusion: In heart transplant recipients, 3D-GLS is an independently predictor of MACE. These findings support the potential of 3D-GLS to identify higher risk HT patients.
Abstract 14958: Association of Smartwatch-Based Resting Heart Rate With Cardiorespiratory Fitness Measures From Cardiopulmonary Exercise Test in the Community
Authors: Yuankai Zhang, Xuzhi Wang, Chathurangi H Pathiravasan, Honghuang Lin, Belinda Borrelli, Nicole L Spartano, Emelia J Benjamin, David D McManus, Martin Larson, Vasan S Ramachandran, Gregory Lewis, JoAnne M Murabito, Matthew G Nayor, Chunyu Liu
Journal: Circulation (2022)

Introduction: Resting heart rate (HR) is an established predictor of cardiorespiratory fitness. Commercial smartwatches permit remote HR monitoring in real world settings over long periods of time, but the relations of smartwatch measured HR and cardiorespiratory fitness in the general public remain uncharacterized. Objective We aimed to examine the associations of resting HR measured with a smartwatch in the electronic Framingham Heart Study (eFHS) with multi-dimensional fitness assessment via cardiopulmonary exercise test (CPET). We hypothesized that participants with lower resting HR would have greater cardiorespiratory fitness. Methods: eFHS participants were enrolled at an FHS research exam (2016-2019) and provided with a study smartwatch that collected longitudinal HR data for up to 3 years. We identified participants’ HR measures in the sedentary state through a classification algorithm to calculate the average resting HR for each participant. At the same exam, participants underwent CPET performed on a cycle ergometer. Multivariable linear models were used to test the association of resting HR with CPET indices. We used P&lt;0.05 for significance. Results: We included 1,051 participants (mean age 52±8 years, 59% women, mean resting HR 77±6 beats/min) with a median of 27,655 HR records for each individual, and median of 266 watch-wearing days. Higher individual resting HR was associated with a lower peak oxygen uptake (VO 2 ; both in ml/kg/min and % predicted), lower VO 2 at the ventilatory anaerobic threshold (VAT), higher (adverse) ventilatory efficiency (VE/VCO 2 ), and unfavorable blood pressure response to exercise (higher mean arterial pressure at 75 watts) ( Table ). Conclusions: Our findings suggest the feasibility of smartwatch-based HR assessment as an indicator of a broad array of cardiorespiratory fitness responses in the community, including measures of global fitness (peak VO 2 ), ventilatory efficiency, and blood pressure response to exercise.
Abstract 15205: Cardiovascular Outcomes With Use of Primary Prevention Implantable Cardioverter Defibrillators in Patients With Non-Ischemic Cardiomyopathy: A Meta-Analysis and Meta-Regression Analysis
Authors: Ahmad Naeem Lone, Priyanka Ghosh, Ali Zaidi, Daniel Sporn, Pramod Deshmukh
Journal: Circulation (2022)

Introduction: Guidelines recommend use of implantable cardioverter defibrillator (ICD) in all patients with non-ischemic cardiomyopathy (NICM) and ejection fraction (EF) &lt; 35% for primary prevention of sudden cardiac death (SCD) and hence reduction of overall mortality. Contemporary randomized clinical trials (RCTs) with longer follow up duration have thrown into question this beneficial effect of ICDs. Hypothesis: Prophylactic use of ICDs in addition to optimal medical therapy (OMT) does not reduce adverse outcomes in patients with NICM and EF &lt; 35% compared to OMT alone. Methods: Six RCTs (n=4541) comparing ICD + OMT vs OMT alone were selected from MEDLINE and EMBASE databases from inception through March 2022. Meta-analysis was performed using random effects model. Meta-regression analysis was performed with inverse-variance weighting and Knapp and Hartung adjustments for all-cause mortality. Results: ICDs did not reduce risk of all-cause mortality (Relative Risk (RR) 0.87, [95% confidence interval, 0.75-1.00], cardiovascular mortality (RR, 0.80 [0.49-1.31]), non-cardiovascular mortality (RR, 0.66 [0.13-3.34]) or non-sudden cardiac death (RR, 1.03 [0.51-2.08]). ICDs reduced the risk of sudden cardiac death (HR, 0.49 [0.26-0.92]). Meta-regression analysis did not show any association between all-cause mortality and follow up duration (p=0.09). Conclusions: ICDs reduce risk of SCD however this does not translate into meaningful improvement in long term cardiovascular outcomes.
Abstract 14951: An Interpretable Machine Learning Model for Predicting Long-Term Clinical Outcomes in Recurrent Pericarditis
Authors: Abdullah Yesilyaprak, Ashwin Kumar, Muhammad M Furqan, Beni R Verma, Ankit Agrawal, Alveena Syed, Kevser Akyuz, Tom Kai Ming K Wang, Paul C Cremer, Allan L Klein
Journal: Circulation (2022)

Background: Recurrent pericarditis (RP) is a complex condition associated with high morbidity. A few studies have evaluated which factors are associated with clinical remission and relapse. However currently, no models exist to predict these outcomes. Objective: We developed an explainable machine learning (ML) model that can predict long-term outcomes in patients with RP and enable identification of patients with worse outcomes. Methods: Consecutive patients with RP (n=365) from 2012-2019 included. The primary outcome was CR. The dataset was partitioned into training and evaluation sets with 5-fold cross-validation approach. The eXtreme Gradient Boosting (XGBoost) method was used to identify predictors for CR, calculate the likelihood of CR within 5 years, and stratify patients into high-risk and low-risk. The performance of the model was evaluated using the C-index. The log-rank test was utilized to assess the difference between Kaplan-Meier curves of risk groups. Finally, an explainable ML approach, SHAP, was deployed to generate both global and individual explanations of the model’s decisions. Results: The cohort was 56% female (n=205) with a mean age of 46 ± 15 years. 61% were idiopathic RP (n=223), 21% were post-cardiac injury syndrome RP (n=77), and 18% were autoimmune RP (n=65) patients. CR was achieved in 32% (n=118). XGBoost risk model included steroid dependency, total no. of recurrences, age, HR, LVEF, gender, etiology, and pericardial delayed gadolinium hyperenhancement as important parameters. The model predicted the outcome with C-index of 0.801 (95%CI, 0.74-0.86) on the validation set and exhibited significant ability in stratification of patients into low- and high-risk groups (log-rank P&lt;0.001). Conclusions: We developed a novel ML-based model for predicting CR, and stratifying patients, with high discrimination ability. The use of an explainable ML model can aid physicians in making individualized treatment decision in RP patients.
Abstract 14750: Mechanical Circulatory Support Devices Among Patients With Familial Dilated Cardiomyopathy
Authors: Naman S Shetty, Vibhu Parcha, Ammar Hasnie, Ambarish Pandey, Garima Arora, Pankaj Arora
Journal: Circulation (2022)

Introduction: With increasing disease recognition and widespread availability of genetic testing, it is important to characterize the clinical outcomes and prognosis among familial dilated cardiomyopathy (DCM) patients with stage D heart failure requiring a mechanical circulatory support device (MCSD). INTERMACS (INTEragency Registry for Mechanical Assisted Circulatory Devices) was examined to assess the clinical characteristics and outcomes of familial DCM patients who received an MCSD. Methods: DCM patients who received an MCSD between June 2005-December 2017 were classified according to their etiology. The primary outcome was death (with heart transplant as a competing risk) and the secondary outcome was heart transplant (with death as a competing risk). Multivariable-adjusted Cox regression analyses were used to assess the risk of study outcomes across DCM etiologies. Results: Among 19,928 DCM patients, 8,622 (43.3%), 7,091 (35.6%), 568 (2.9%), and 3,647 (18.3%) had ischemic DCM, idiopathic DCM, familial DCM, and DCM due to other causes respectively. Familial DCM patients had the lowest median age at implantation [46 (34, 56) years] compared with other DCM etiologies. Bridge to transplant was the most common device strategy (78.4%) in the familial DCM group (45.6% were listed and an additional 32.8% were eligible for a heart transplant). Familial DCM patients had the lowest adverse events of bleeding, device thrombosis, infection, and respiratory failure post-MCSD implantation. Over a median follow-up of 1.0 (0.4, 2.0) years, familial DCM patients had the lowest risk of death [HR adj : 0.68 (95% CI: 0.55-0.83)] and the highest likelihood of heart transplantation [HR adj : 1.47 (95% CI: 1.28-1.69)] compared with the other DCM groups. Conclusions: Among DCM patients receiving MCSDs, familial DCM patients had the lowest adverse events, the lowest risk of death, and the highest likelihood of heart transplantation, compared with other DCM etiologies.
Abstract 15003: A Circulating Genetic Signature in Psoriasis Associates With Future Cardiovascular Events
Authors: Michael S Garshick, Macintosh Cornwell, Kamelia Drenkova, Tessa A Barrett, Maria Florencia Schlamp, Kelly Ruggles, Caron Rockman, Harmony Reynolds, Jeffrey Berger
Journal: Circulation (2022)

Introduction: Psoriasis (PsO) is an inflammatory skin disease associated with cardiovascular (CV) disease (CVD). Multiple biomarkers are proposed to enhance risk assessment in PsO, yet the overlap between biomarkers of PsO and CV risk are incompletely understood. We therefore investigated the whole blood transcriptome in PsO, and prevalence and future risk of a CV event. Methods: PsO patients (n=37), without CV disease and 11 age-, sex-matched controls underwent whole blood RNA sequencing. The upregulated genetic signature in PsO vs controls was then evaluated in CVD cohorts: Group 1) women referred for cardiac catheterization for (n=26, median age 61 [IQR; 54 - 70] years) vs without (n=41, median age 62 [IQR; 58 - 69] years) an active myocardial infarction (MI), group 2) patients with peripheral artery disease followed longitudinally for major adverse CV or limb events (MACLE; n=106, median age 66 [IQR; 60 - 72] years, 74% male, median follow-up 2.5 years). Results: In the PsO cohort, median age was 44 (IQR; 34 - 51) years, 49% male, and ACC/AHA ASCVD Risk Score of 1.0% (0.6 - 3.4) with no significant difference vs controls. The median psoriasis area and severity index score (PASI) was 4.0 (IQR 2.9 - 8.2), PsO duration 15 (IQR; 9 - 25) years, with 36% on biologic therapy. Overall, 247 genes were upregulated and 228 downregulated in PsO vs controls (Figure 1A, p&lt;0.05), and 1,302 genes positively and 1,244 genes negatively associated with PASI (Figure 1B, p&lt;0.05). Seventy-three genes overlapped between these two comparisons (Figure 1C); key cytokine regulators were IL-6, IL-1β, and IFN gamma (Figure 1D). In the CVD cohorts, 50 out of 73 genes (68%, group 1) significantly associated with prevalent MI, and 29 (40%, group 2) with incident MACLE (Figure 1E). Conclusions: A whole blood transcriptomic signature of PsO diagnosis and severity was associated with prevalent MI and incident MACLE. These data have implications for understanding the link between PsO, systemic inflammation, and CVD.
Abstract 14618: Mitochondria-Rich Extracellular Vesicles From Stem Cell-Derived Cardiomyocytes Restore Cardiac Energy Metabolism of Ischemic Myocardium in a Preclinical Pig Model
Authors: Gentaro Ikeda, Hiroyuki Takashima, Chunli Zhao, Nathan Bayardo, jennifer lyins, Connor O'Brien, Phillip C Yang
Journal: Circulation (2022)

Introduction: Disruption of mitochondrial energy metabolism underlies the pathophysiology of heart failure. We previously demonstrated that intramyocardial injection of mitochondria-rich extracellular vesicles (M-EVs) from iPSC-derived cardiomyocytes (iCMs) transfer mitochondrial and nonmitochondrial substances into the recipient cardiomyocytes, stimulating mitochondrial biogenesis and functional capacities in the murine acute myocardial infarction (MI) model. However, the therapeutic potential and underlying mechanism in larger animal models remain to be assessed. Methods: M-EVs were isolated from the conditioned medium of iCMs via differential ultracentrifugation. Yorkshire pigs were subjected to myocardial ischemia for one hour via balloon occlusion of the left anterior descending artery. 1.0 x 10 11 M-EVs were injected into the infarct border zone using a percutaneous catheter delivery system (Biocardia, Inc). Cardiac functions were analyzed by cardiac MRI. Liquid chromatography-tandem mass spectrometry was performed to investigate comprehensive protein profiles of M-EV content and pig heart tissue samples. Results: Flow cytometric and electron microscopic analysis revealed that mitochondria inside M-EVs retained membrane potentials and structural integrities. M-EV therapy significantly improved left ventricular (LV) ejection fractions (30.5 vs. 21.2 %, p=0.004) and reduced LV end-diastolic volume (119 vs. 192 mL, p=0.047) at week-4 as compared with PBS control. No difference was observed in the scar size. Proteomics analysis identified a total of 37 significantly enriched proteins in M-EVs. Gene Set Enrichment Analysis of the M-EV proteome revealed significantly upregulated biological processes, including oxidative phosphorylation. STRING network analysis identified enriched proteins that directly or indirectly interact with a proliferator-activated receptor γ coactivator-1 α, a master regulator of mitochondrial biogenesis. Conclusion: M-EV-mediated transfer of mitochondria and enriched proteins enhanced cardiac function by restoring energy metabolism in pig acute MI model. M-EV therapy may represent a novel biologic that directly targets energy metabolism in mitochondria-related diseases.